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r -rrRc UZt: APPLICATION FOR SANITATION PERMIT tComplete In Triplicate) Permit No. .7�-...3 --•--•--•• ----•-•••- This Permit Expires if Year From Onto issued Date issued .677. J._-. 2-55 -3�e� !� Apttion is hereby ma eta to San Joaquin local Health District for a permit to construct and install the work herein E described, This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulatiom �..JOB ADDRESS/LOCATION ..'�. 7of �F• /lam s ..3..3 ....CENSUS T RACTS...-.Z..3...°-.`...�....�...�. .. Owner's Name ........ �r} rfiiL f ......... Phone Address -....- �' �_..._.. . City Contractor's Nome � �---�f ............._.___.License # Phone _..._._..-•-------------�-•� Installation will serve: Residence❑Apartment House C) Commercial❑Trailer Court 0 Motel ❑Other•--------_---- --•---•-• --------------•- - 4 Number of living units:___ ------ Number of bedrooms __- ......Garbage Grinder ------------ Lot Size __'x`-.._A ® Water Supply: Public System and name ............._..................................... Private.,( Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam o Clay Loam o Hardpan ❑ Adobe❑ Fill Material ----......- if yes,type............... ............ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) - PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size........-_---•- -------------- Liquid Depth ............... '* Gc ey--Capacity/�O�' Type � c--• fMaterial-- - ---- No. Compartments ..................... Distance to nearest: Well ------- �- ------- ------Foundation .'-'ter ............ Prop. Line __�� *.--••---- LEACHING LINE [ j No. of Lines ______- ___-_- _.___ Length of each line--..��_______________ Total length °Z.��_ ---�--- a 'D' Box Type Filter Material _. "�-. ......Depth Filter Material ....�O.-'-.... Distance to nearest: Well ..............:......... Foundation ...Pj............. Property Line .4.FR!........ - SEEPAGE PIT [ ) Depth _------------------ Diameter ----------- .... Number _-------..-------,____.._--- Rock Filled Yes ❑ No C3 Water Table Depth ----••------•-•--•---• ----•-- ------------- -•Rock Size -----..._ ................... -- + Distance to nearest: Well.----------------------------------------Foundation ------.............. Prop. Line ...................... REPAIR/ADDITION(Prey. Sanitation Permit# _________________ ................... Date -----••.............................) Septic: Tank (Specify Requirements) ...................---•--••-•-------_--- ....... .................. -......... i Disposal Field (Specify Requirements) ............................ _--•-------------_ --_ ------------------------.------------------ ...._... + u ----•-----•---------•-•----------------- ------------------------------------------ ----------•----- I--------------_---- _----- -- (Draw existing and required addition on reverse side} I hereby, certify that I have prepared this applications and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed -_2. _._4/7 -•--e---Su lu..._..._--••- -------------------- Owner BY -------- .. ------• Title ---------------------- (If other t er) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- DATE ..- r __. ._ BUfLDING PERMIT ISSUED ----------------------- -•- ----DATE -.--.._...__._..._.. ADbITIONA! COMMENTS ----------••- -----------------_ --_._---' ----- ...................-.......------- --------- •---...__...----...----•------- •-----------.. •-----------•---------- --- -- ----.............-•---- ` .. ........------------------------------------- ____________________ ___ -.__._.__-_.-i--_._._.- ..........___-___Y.r Final Inspection by: ..... Date _.....-- •------ - EH 13 2a 1.-68 Heves 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M r�